Provider Demographics
NPI:1730222811
Name:GARY T. BREWER
Entity type:Organization
Organization Name:GARY T. BREWER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-229-0407
Mailing Address - Street 1:504 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEALDTON
Mailing Address - State:OK
Mailing Address - Zip Code:73438-1801
Mailing Address - Country:US
Mailing Address - Phone:580-229-0407
Mailing Address - Fax:580-229-0418
Practice Address - Street 1:504 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HEALDTON
Practice Address - State:OK
Practice Address - Zip Code:73438-1801
Practice Address - Country:US
Practice Address - Phone:580-229-0407
Practice Address - Fax:580-229-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty